THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS CERTIFICATION IN GYNAECOLOGICAL ONCOLOGY

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1 THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS CERTIFICATION IN GYNAECOLOGICAL ONCOLOGY TRAINING PROGRAM HANDBOOK 2016

2 Published by RANZCOG Publications The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Albert Street, East Melbourne, Victoria 3002, Australia RANZCOG 2014 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Requests and enquiries concerning reproduction should be directed to the Chief Executive Officer, RANZCOG, Albert Street, East Melbourne, Victoria 3002, Australia. 2

3 IMPORTANT NOTICE ON INFORMATION AND REGULATIONS IN THIS HANDBOOK Every effort has been made to ensure that the information and College regulations in this handbook were correct at the time it was produced. A regularly updated version of the handbook is available on the College website (www.ranzcog.edu.au) Readers are strongly advised to consult the website version when checking information or regulations. Updated December

4 Table of Contents Part A: Administration 1.0 College Information Dates for College House Staff Contact Details 1.3 College Training and Education Committees 1.4 Current CGO Subspecialists 1.5 Accredited CGO Training Units and Program Directors 2.0 Training Administration A Year-By-Year Guide for Trainees 2.2 Applying for Prospective Approval to Commence Training 2.3 Applying for Prospective Approval to Continue in the CGO Training Program 2.4 Applying for Part time Training 2.5 Applying for Leave From Training 2.6 Training in an Overseas Training Unit 2.7 Registration and Training Fees 2.8 Timeline for Training in CGO 2.9 Applying for Certification as a CGO Subspecialist 3.0 Accreditation of CGO Training Units Standards for the Accreditation of a CGO Training Unit 3.2 Applying for Accreditation as a CGO Training Unit Part B: Curriculum 1.0 Aims Subspecialist Practice 1.2 Context 1.3 Aims of the Subspecialties 1.4 Aims of the Subspecialty in Gynaecological Oncology 2.0 Objectives of the CGO Training Program Knowledge and Understanding Epidemiology and Aetiology 3.2 Anatomy 3.3 Physiology and Pathophysiology 3.4 Genetics 3.5 Pharmacology and Therapeutics 3.6 Pathology 3.7 Immunology 3.8 Analysis of Clinical Information and Research 3.9 Diagnostic Techniques 3.10 Clinical Management 3.11 Professionalism and Management 3.12 Teaching 3.13 Ethics and the Law 3.14 Culture 4

5 4.0 Clinical and Management Skills Gynaecological Oncology 4.2 Surgical Skills 4.3 Surgical Procedures 4.4 Critical Care 4.5 Management and Professional Responsibilities 4.6 Research Skills 5.0 Recommended Resources Texts 5.2 Journals 5.3 Websites 6.0 CGO Training Program Requirements of the CGO Training Program 6.2 Components of the CGO Training Program 7.0 Assessment Training Documentation 7.2 Research Project 7.3 Surgical Skills Assessment 7.4 Examinations 7.5 RANZCOG Policy on Exceptional Circumstances and Special Consideration 7.6 Bullying, Harassment and Discrimination in the Workplace Policy Part C: Appendices 73 A1.0 Terminology A1.1 Acronyms A1.2 Abbreviations Used / Accepted in CGO Subspecialty Examinations and Training Documentation A1.3 Glossary of Terms A2.0 CGO Subspecialty Committee Function and Terms of Reference 80 5

6 Part A: Administration 1.0 COLLEGE INFORMATION 6

7 Part A: ADMINISTRATION Part A 1.0 College Information 1.1 Dates for January Final date for payment of annual training fee 1 February Semester 1 commences (Australia) 1 February Final date for submission of Certification applications for March Board March March Council 31 March Final date for National Selection Process 2016 (2017 entry) applications 31 March Final date for applications to sit Subspecialties Written and Oral Examinations for 2016 candidates 1 June Final date for submission of Certification applications for July Board 6 June Semester 2 commences (New Zealand) 24 June (TBC) CGO National Selection Process 2016 (2017 entry) interviews 19 July Subspecialties Written Examinations July July Council 1 August Semester 2 commences (Australia) 1 October Final date for submission of Certification applications for November Board November November Council 20 November CGO Oral Examination 5 December Semester 1 commences for 2017 (New Zealand) NOTE LATE APPLICATIONS FOR RANZCOG EXAMINATIONS AND CERTIFICATION WILL NOT BE ACCEPTED Please refer to the relevant College Regulations in the RANZCOG Regulations Section D: Subspecialty Training 7

8 Part A: ADMINISTRATION 1.0 College Information 1.2 College House Staff Contact Details Director, Training and Education Ms Lyn Johnson tel fax Manager, Educational Services Ms Lois Lowe tel fax Subspecialties Services Name and Position Area of responsibility Contact details Ms Jolene Davidson Senior Subspecialties Coordinator Ms Georgina Sack Subspecialties Services Coordinator Mrs Kate Gilliam Subspecialties Training Coordinator Subspecialties Training Policies Recertification Accreditation of Subspecialties Training Units Subspecialties Committees Coordination National Selection Process Subspecialties Trainee Enquiries Subspecialties Registration / Training Documentation Subspecialties Research Projects IHCE tel fax tel fax tel fax Assessment Services General assessment address: Name and Position Area of responsibility Contact details Ms Lisa Del Din Senior Assessment Coordinator Assessment Services Policies and Procedures tel fax To be advised EAC Coordinator / Examinations Administrator Subspecialties To be advised Examinations Administrator Board of Examiners Education and Assessment Committee Subspecialties Examinations Subspecialties Examinations 8

9 Part A: ADMINISTRATION Part A 1.0 College Information 1.3 College Training and Education Committees Standing Committees of Council have been established to formulate and review training and assessment requirements leading towards the attainment of MRANZCOG/FRANZCOG and Subspecialty qualifications. Council Committees usually meet in March, July and November. Education Assessment Committee Chair: Professor Ian Symonds Responsibilities of the Education Assessment Committee: Development and maintenance of requirements for the examinations and assessments leading towards MRANZCOG, FRANZCOG and Subspecialty certification Assessment Subcommittee Training Accreditation Committee Chair: Dr Sarah Tout Responsibilities of the Training Accreditation Committee: Approval of hospitals and training posts suitable for MRANZCOG/FRANZCOG training and the development of training programs Consideration and assessment of individual trainee programs leading towards MRANZCOG/ FRANZCOG Consideration of applications for admission to MRANZCOG and elevation to FRANZCOG Coordination of the development and maintenance of the training requirements associated with the MRANZCOG/FRANZCOG Coordination of the Core Training Program hospital re-accreditation process, including site visits to hospitals Subspecialties Committee Chair: Dr John Tait Responsibilities of the Subspecialties Committee: Development of training and assessment requirements to achieve qualification in the relevant subspecialty Consideration and assessment of individual trainee applications and programs leading to the award of a subspecialty qualification Consideration and assessment of Specialist International Medical Gaduates seeking a RANZCOG subspecialty qualification Determination of the requirements for recertification in the relevant subspecialty Certification in Gynaecological Oncology (CGO) Subspecialty Committee Chair: Dr Rhonda Farrell Responsibilities of the CGO Subspecialty Committee: Development of training and assessment requirements to achieve certification in the GO subspecialty Consideration and assessment of individual trainee applications and programs leading to the award of certification in GO Consideration and assessment of Specialist International medical Graduates seeking a RANZCOG qualification in GO Determination of the requirements for recertification in the GO subspecialty Refer to Appendix 2 of this handbook for Functions and Terms of Reference of the CGO Subspecialty Committee. All correspondence pertaining to the work of these committees should be forwarded to the Chair of the relevant committee at the address below. c/o RANZCOG Albert St East Melbourne VIC

10 Part A: A ADMINISTRATION 1.0 College Information 1.4 CURRENT CGO SUBSPECIALISTS New South Wales Victoria Queensland Dr A Brand Professor J Carter Dr F Chan Dr J Dalrymple Dr R Farrell Dr G Gard Professor N Hacker A/Professor R Hogg Dr K Jaaback Dr G Otton A/Professor S Pather A/Professor A Proietto Dr A Rao Dr A Richards Dr G Robertson Dr S Valmadre Dr G Wain A/Professor D Allen Dr V Arora A/Professor P Grant Dr S Hyde A/Professor T Jobling Dr J Lamont Dr T Manolitsas Dr O McNally Dr L McNeilage Dr D Neesham Professor M Quinn Dr K Reid A/Professor R Rome Dr N Chetty Professor A Crandon Dr A Garrett Dr R Land A/Professor J Nicklin Professor A Obermair A/Professor L Perrin Dr M Nascimento Dr P Singh Dr A Tang South Australia Western Australia Tasmania New Zealand Overseas Dr M Davy Dr R Miller Professor M Oehler Dr S Paramasivam Professor Y Leung Dr R Kader Ali Mohan Dr S Salfinger Dr J Tan Dr M Bunting Dr P Blomfield Dr B Simcock Dr P Sykes Dr A-L Tan Dr J Whittaker Dr D Cheng (HK) Mr P Larsen-Disney (UK) 10

11 Part A: ADMINISTRATION Part A 1.0 College Information 1.5 Accredited CGO Training Units AND Program Directors State/Country Training Unit Program Director Accreditation Period Victoria Mercy Hospital for Women, Melbourne Royal Women s Hospital, Melbourne Monash Medical Centre, Melbourne Dr Simon Hyde 01/01/ /12/2018 Dr Orla NcNally 01/01/ /12/2018 A/Professor Tom Jobling 01/01/ /12/2018 Royal Hospital for Women, Sydney Professor Neville Hacker 01/01/ /12/2018 New South Wales Royal Prince Alfred and Concord Hospitals, Sydney Professor Jonathan Carter 01/01/ /12/2018 Hunter New England Hospital, Newcastle Dr Geoff Otton 01/01/ /12/2018 Queensland Royal Brisbane and Women s and Mater Mothers Hospitals, Brisbane Gold Coast University Hospital, Southport Professor Alexander Crandon A/Professor James Nicklin 01/01/ /12/2018 Dr Marcelo Nascimento 01/01/ /12/2018 South Australia Royal Adelaide Hospital, Adelaide Professor Martin Oehler 01/01/ /12/2018 Flinders Medical Centre Dr Sellva Paramasivam 01/01/ /12/2018 Western Australia West Australian Gynaecological Cancer Service and King Edward Memorial Hospital for Women, Perth Professor Yee Leung 01/01/ /12/2018 Auckland City Hospital, Auckland Dr Ai Ling Tan 01/02/ /01/2019 New Zealand Christchurch Women s Hospital, Christchurch Dr Bryony Simcock 01/01/ /12/

12 Part A: administration 2.0 Training ADMINISTRATION 12

13 Part A: ADMINISTRATION 2.0 training administration 2.1 A Year-By-Year Guide for Trainees YEAR 1 YEAR 2 YEAR 3 POST YEAR 3 Gynaecological Oncology (compulsory) Minimum of 2 years in a gynaecological oncology unit Training General Surgery (desirable) One year at an advanced level Medical Oncology (desirable) No more than three months Radiotherapy (desirable) No more than three months Pathology Sessions Attendance at pathology sessions, including tumour board meetings Submit Three-Monthly Appraisals within four weeks of the end of each relevant three month period Submit Six-Monthly Summative Assessment and entire TAR within six weeks of the end of each relevant six month period Surgical Skills Assessments Seven compulsory surgical skills assessments must be completed by the end of Year 2 of clinical training, and a further three must be completed by the end of Year 3 of clinical training College Approved Professional Development Programs Recertification Requirements Assessment Multi-Source Feedback (MSF) - Semester 2 Research Project Proposal (draft), including timeline Research Project Proposal (final), including ethics committee approval Written Examination Oral Examination Research Project completed within 92 weeks (24 months) FTE of completion of clinical training 13

14 Part A: ADMINISTRATION 2.0 training administration 2.2 Applying for Prospective Approval to Commence Training Applicants should refer to the Subspecialties National Selection Process 2016 (2017 entry) - Information for Applicants document on the website for full details. Eligibility To be eligible to apply to join a subspecialty training program in Australia or New Zealand, doctors must have successfully completed and been accredited with at least 138 weeks (36 months) FTE of satisfactory Core Training, passed the MRANZCOG Written Examination, passed the MRANZCOG Oral Examination, or have applied to sit the MRANZCOG Oral Examination to be held in the first half of the year in which they intend to apply to join a subspecialist training program, or have obtained the FRANZCOG. Doctors must also possess medical registration in the relevant State or Territory with no restrictions, conditions, undertakings or any other limitations that would adversely impact on or limit their ability to train toward and ultimately act as a subspecialist in the subspecialty(s) it is intended to apply for. Trainees can apply in Year 4 of Core Training to commence subspecialty training in Year 5. From 1 December 2013, successful completion of all Core Training requirements, including advanced surgical skills (for trainees who commenced FRANZCOG training 1 December November 2013) or satisfactory completion of the Research component of the FRANZCOG training program (for trainees who commenced FRANZCOG training on or after 1 December 2013), must be achieved before subspecialty training can commence in Year 5. Applications - National Selection Process The CGO Subspecialty Committee will advertise annually (in the January, February and March issues of the Training and Assessment Bulletin and Collegiate, and the March issue of O&G Magazine) for prospective CGO trainees to apply through the National Selection Process for a training position in the CGO Subspecialty Training Program which leads to certification as a subspecialist in Gynaecologic Oncology. Successful National Selection Process candidates are then responsible for obtaining their own position in an accredited CGO training unit. All applicants must use the official RANZCOG National Selection Process application form available on the College website and submit their application, including a covering letter, to College House addressed to the Chair of the CGO Subspecialty Committee. Applicants must note that they are required to provide the details of three (3) referees. These referees must be - a) a senior colleague (FRANZCOG or equivalent) with whom the applicant has worked in the previous two years. If applicants are still completing FRANZCOG training, this senior colleague must be the Training Supervisor. b) two other colleagues with whom the applicant has worked in the last two years. Applicants are advised to contact the College to confirm the application closing date for the National Selection Process. Interviews are generally held in May/June for entry into the program the following year. Selection Criteria Applicants will be assessed against the following Selection Criteria: Educational history Employment history Professional development Commitment to the subspecialty Teaching and leadership experience Research Publications and Presentations CGO-specific elements Referee reports For trainees who commenced subspecialty training prior to 1 December 2014, subspecialty training for the CGO, CREI and CU programs must be undertaken in a minimum of two training units during the three year program. Prospective candidates should note that trainees commencing subspecialty training from 1 December 2014, in all subspecialties, must undertake subspecialty training in a minimum of two training units during the three year clinical program. For CGO trainees, training must be in two accredited CGO training units unless otherwise prospectively approved by the CGO Committee. The minimum time in one unit will be the equivalent of six months full time training. 14

15 Part A: ADMINISTRATION Part A 2.0 training administration Entry Level Knowledge for CGO 1. Candidates are strongly advised to review the following areas: Anatomy, Genetics, Surgical Pathology (including neoplasia), and Immunology. These areas must be known at the level required for MRANZCOG and at the applied subspecialty tertiary referral level. 2. Candidates must be well acquainted with public health and social concerns in the subspecialty, including the medical, ethical, social, and legal aspects of gynaecological oncology. 3. Candidates should be familiar with current literature that is relevant to the gynaecological oncology discipline. 4. Candidates must be able to monitor and manage their own and their institution s practices, carry out their own research studies, and analyse the work of others critically. The candidate must therefore have a thorough practical understanding of the statistical and managerial methods used in the field. Interview Panel The interview panel consists of three panelists, one of whom is the Chair of the CGO Subspecialty Committee. All applicants will be notified in writing of the outcome of the interview. Registration Following confirmation of a training post, the prospective trainee will need to register as a RANZCOG Subspecialty Trainee and pay the Annual Training Fee. Trainees must submit an application for prospective approval of training to College House at least eight weeks prior to the commencement of training, in each year of training. Only training that has been prospectively approved will be credited by the College. The RANZCOG Registration and Prospective Approval of Training forms are available on the College website. In some circumstances, a trainee who was selected as suitable to join the training program, may be eligible to begin their training in July of the interview year provided the trainee is - already working as a Subspecialist Fellow in an accredited training unit in a position gained by a competitive entry process or interview; and already in their fifth or sixth year of training or a FRANZCOG If applicable, trainees must apply to the CGO Subspecialty Committee. Approval will be given on a case-by-case basis. In such a case, Prospective Approval must still be attained eight weeks prior to any training time being credited. Timeframes for commencing training are June to August and December to February each year. 2.3 Applying for Prospective Approval to Continue in the CGO Training Program All CGO Trainees are required to apply for prospective approval of training for each year of training. This includes clinical and research experience. Applications for prospective approval of training must be made on the official RANZCOG Registration and Prospective Approval of Training forms available on the College website. Trainees must submit an application for prospective approval of training to College House at least eight weeks prior to the commencement of training. Only training that has been prospectively approved will be credited by the College. Some trainees find that circumstances and opportunities change during the CGO Training Program. The Trainee and the Training Supervisor should communicate this to the CGO Subspecialty Committee as soon as possible. 2.4 Applying for fractional time Training Trainees are advised to consult the RANZCOG Regulations Section D: Subspecialty Training for regulations pertaining to part time training. Year 1 of CGO subspecialty training must be undertaken on a full time continuous basis. In subsequent years, part time training may be approved. All part time training must not be less than half of the full time training requirement for the relevant training period at the relevant training site and the duration of the training program must be extended appropriately for that trainee. All part time training must include a range of experience appropriate to the trainee s year level, as well as appropriate supervision. 2.5 Applying for Leave From 15

16 Part A: ADMINISTRATION 2.0 training administration Training Trainees are advised to consult the RANZCOG Regulations Section D: Subspecialty Training for regulations pertaining to taking leave from training. The maximum number of weeks able to be credited in any period covered by a Six-Monthly Summative Assessment is 26 weeks FTE, with a maximum of 46 weeks FTE of training able to be credited for training undertaken in a subspecialty training year. A subspecialty training year consists of two consecutive six month training blocks based around (but not confined to) a calendar year and is determined by the CGO Subspecialty Committee. This applies irrespective of any government or hospital leave entitlements which may operate in a particular state or region. In addition to the six weeks leave per year allowed, trainees are permitted up to two weeks of studyconference leave per year, which is recognised as part of active clinical service. This study/conference leave must be prospectively approved using the Application for Leave form available on the College website. At each Six-Monthly Summative Assessment, the trainee and his/her supervisor must sign off on the number of weeks of leave taken during the six-month training period. The nature of the leave must also be indicated. This signing-off process is done using the leave box which appears on the six-monthly assessment form. Trainees must also maintain, in their Training Assessment Record, an accurate record of all leave taken during the three year training period. Any leave in excess of normal leave entitlements must be prospectively approved by the Chair of the CGO Subspecialty Committee using the Application for Leave form available on the College website. If necessary, the Chair may discuss the leave application with the CGO Subspecialty Committee. The application for leave approval must be made with the knowledge and agreement of the Training Supervisor. 2.6 Training in an Overseas Training Unit Trainees are advised to consult the RANZCOG Regulations Section D: Subspecialty Training for regulations pertaining to undertaking training in an overseas training unit. Trainees may undertake part of their training in an overseas training unit. As with all training, overseas training must be prospectively approved by the CGO Subspecialty Committee. Trainees must provide a plan for completion of training on return to Australia and New Zealand and commitment of support from an Australian or New Zealand Training Supervisor. As with training in Australia or New Zealand, trainees overseas are required to submit all training documentation within the specified timelines to College House. The guidelines and regulations that govern registration, fees and training documentation also apply to trainees overseas. In some hospitals, the consultants with whom the trainee works and the Training Supervisor may not be familiar with the forms and training documentation requirements. Trainees will need to provide consultants and their Training Supervisor with the necessary documentation and explain how it is used. 2.7 Registration and Training Fees All fees are reviewed annually and subject to change. Training Annual Training Fee $AU 2, Late Lodgement Fee National Selection Process Application Fee 10% annual fee per month $AU Re-instatement Fee $AU 1, Assessment Subspecialties Written Examination $AU 1, Subspecialties Oral Examination $AU 3, Special Consideration Application $AU Recognition of Prior Learning Assessment Specialist International Medical Graduate Assessment Certification Fee $AU 2, $AU 2, Subspecialties Certification Fee $AU All fees are quoted in Australian dollars and are GST exempt, unless otherwise indicated. All fees are reviewed annually and subject to change. Trainees must submit their RANZCOG registration 16

17 Part A: ADMINISTRATION Part A 2.0 training administration form to College House by 31 January each year. A registration form must be submitted even if the trainee is not intending to train in the relevant year. All trainees, regardless of whether training full time or part time, must pay the full training fee to the Finance Department at College House by 31 January of each year unless specifically designated in the RANZCOG Regulations Section D: Subspecialty Training. Trainees who take Extended Leave of Absence must remain on the Register of Trainees and where leave has been taken for an entire training year, are required to pay 25% of the training fee to the Finance Department at College House by 31 January of that year. Where a trainee has, due to an approved period/s of Extended Leave of Absence, trained for less than 23 weeks (FTE) in a training year, the trainee shall receive a refund of 33% of the training fee for that year. This refund shall be paid by the College following the conclusion of the training year. Subspecialty trainees who discontinue their registration as a registered RANZCOG trainee and subsequently apply to rejoin the same subspecialty program within two years will be required to pay half the annual training fee for the period of time between the last record of registration as a subspecialty trainee and recommencement of subspecialty training. Trainees who do not submit a registration form and/or pay the annual training fee by 31 January of each year will be regarded by the College as unregistered and/ or unfinancial. Training undertaken while unregistered and/or unfinancial will not be credited even if prospective approval of training has been obtained. Trainees who remain in arrears with RANZCOG fees, including the annual training fee, will be ineligible for all RANZCOG examinations. 17

18 Part A: ADMINISTRATION 2.0 training administration 2.8 Timeline for Training in CGO YEAR ONE YEAR TWO YEAR THREE Register and pay fees by 31 Januay Start planning research project Register and pay fees by 31 January Register and pay fees by 31 January Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Six-Monthly Summative Assessment: Submit entire TAR with draft research project proposal, including timeline, and feedback questionnaire to College House within six weeks of the end of the relevant six month period Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Multi-Source Feedback (MSF) Semester 2 Apply for Prospective Approval of training eight weeks prior to the commencement of training Six-Monthly Summative Assessment: Submit entire TAR with feedback questionnaire and final research project proposal, with institutional ethics committee approval to College House within six weeks of the end of the relevant six month period Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Apply for examination(s) by 31 March. Eligible for Written examination after satisfactory completion of 46 weeks (12 months) FTE prospectively approved training. Six-Monthly Summative Assessment: Submit entire TAR with feedback questionnaire, and research project progress report to College House within six weeks of the end of the relevant six month period Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Apply for Prospective Approval of training eight weeks prior to the commencement of training Six-Monthly Summative Assessment: Submit entire TAR with feedback questionnaire and research project progress report to College House within six weeks of the end of the relevant six month period Complete Surgical Skills Assessments MUST COMPLETE OVER THREE YEAR PERIOD Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Apply for examination(s) by 31 March. Eligible for Oral examination after satisfactory completion of 92 weeks (24 months) FTE prospectively approved training. First attempt must be within two years of completion of clinical training. Six-Monthly Summative Assessment: Submit entire TAR with research progress report and feedback questionnaire to College House within six weeks of the end of the relevant six month period Submit Three-Monthly Formative Appraisal Report to College House within four weeks of the end of the relevant three month period Six-Monthly Summative Assessment: Submit entire TAR with research project progress report and feedback questionnaire to College House within six weeks of the end of the relevant six month period Research project must be submitted within two years post clinical training and assessed satisfactory within three years post clinical training Personal performance of minimum numbers of a variety of scans and procedures. Participation in specialist units Involvement in pathology sessions, including tumour board meetings Designated Workplace Based Assessments 18

19 Part A: ADMINISTRATION Part A 2.0 training administration 2.9 Applying for Certification as a CGO Subspecialist Trainees are advised to consult the RANZCOG Regulations: Section D Subspecialty Training for regulations pertaining to subspecialty certification. Subspecialty certification is awarded to persons who have met all the following requirements - Joined the CGO Subspecialty Training Program in Australia and New Zealand after obtaining an approved Australian or New Zealand subspecialty training position Have passed the following assessments: -- the Research Project -- completed all the Components of the CGO Training Program requirements -- the Written Examination -- the Oral Examination -- designated Workplace Based Assessments Have satisfactorily completed and been credited with 138 weeks (36 months) FTE prospectively approved subspecialty training Have submitted all documents required by these regulations and/or the CGO Subspecialty Committee Have paid all required training, examination, certification and subscription fees Achieved all of the above within six years of satisfactorily completing approved CGO subspecialty training Have been admitted by the Board as a Fellow of the RANZCOG Satisfactorily completed the requirements of the CGO training program, including completion of all associated administrative requirements Trainees must submit an Application for Subspecialty Certification form available from the College website to the Subspecialties Services at College House in Melbourne. 19

20 Part A: administration 3.0 Accreditation of CGO Training Units 20

21 Part A: ADMINISTRATION 3.0 Accreditation of CGO Training Units 3.1 Standards for the Accreditation of a CGO Training Unit Workload Manage a minimum of 150 new cases of invasive gynaecologic malignancy per year and 50 tertiary referred gynaecology or obstetric emergencies Sufficient workload to maintain and develop the clinical skills of existing personnel and to train CGO trainees Staff One or more on-site certified gynaecologic oncologists who will act as Training Supervisors. If there is only one CGO subspecialist, then the unit can only be approved for a maximum of one year of training per trainee. A certified gynaecologic oncologist who will act as Program Director and coordinate the training program, accept the responsibility for supervision and be actively involved in the training process Appropriate liaison/interface with a colposcopist* Appropriate liaison/interface with a medical oncologist with interest and expertise in gynaecologic oncology* Appropriate liaison/interface with a radiation oncologist with interest and expertise in gynaecologic oncology * Appropriate liaison/interface with a palliative care physician with interest and expertise in gynaecologic oncology * Appropriate liaison/interface with a gynaecologic pathologist * Appropriate liaison/interface with gynaecologists managing pre-invasive disease* A team of identifiable gynaecologic oncology nurses Facilities A minimum of 10 designated gynaecological oncology beds Access to relevant diagnostic modalities including CT, MRI and PET scanning, ultrasound and FNA cytology Facilities for high dependency care Appropriate facilities for assessment and followup Adequate access to library and information technology facilities to support subspecialty work, training and research, over and above that required for the recognition of MRANZCOG and higher training posts Activities Cancer register and data collection Written and agreed treatment protocols Research program related to gynaecologic oncology Regular minuted Tumour Board/Clinicopathology meetings Regular education, peer review, practice review, and clinical management meetings at a subspecialty level Representation at hospital and local clinical, multidisciplinary and scientific meetings Involvement in education at nurse, undergraduate and postgraduate levels * Liaison/interface with associated disciplines must satisfy the training requirements as outline in the Training Program. 3.2 Applying for Accreditation as a CGO Training Unit Departments need not necessarily carry out every possible subspecialty activity to be involved in the training of specialists for the qualification of CGO. In applying for accreditation, prospective training units can submit joint applications in which activities in more than one institution complement each other. A detailed application for accreditation as a training unit should be submitted to the CGO Subspecialty Committee, on the electronic accreditation template available from Subspecialties Services. Where necessary the committee would organise a site visit by its representatives who would include at least one College certified subspecialist and one Fellow not involved in the subspecialty. In most cases, this process will take place before the anticipated time of an appointment to the training position. In order to maintain approved unit status, a review of Training Assessment Records produced by the Trainee on the quality of the training provided by the training unit must be considered satisfactory. 21

22 Part A: ADMINISTRATION 3.0 Accreditation of CGO Training Units An institution fulfilling all of the criteria could be approved for two or more years of training responsibility. Those units that fall short of fulfilling all of the requirements may be approved for one year of training responsibility per trainee. A trainee must complete two years full time (or its part time equivalent) in a public hospital training site. A maximum of two training positions per unit is applicable at any one time. Re-accreditation of a training unit should take place every five years or earlier if there has been a change in the staffing or services provided. Documentation Required The application document must include: A. Evidence of Workload A qualitative (i.e. how and by whom the clinical service is delivered) and quantitative (i.e. an indication of the number of patients seen and procedures performed) description of the clinical services provided in the unit in the last 12 month period. Details of procedures which will be either performed by CGO trainees or at which CGO trainees will act as first assistant must be highlighted The committee may, at its discretion, request procedure numbers at more regular intervals than the full accreditation period, to inform decision making and ensure curriculum requirements remain relevant and appropriate B. Evidence of Staff Names, postnominals and titles of practitioners working at a subspecialty level in the unit. Proportion of time these practitioners spend working at the subspecialty level in the unit. Past responsibilities for trainees these practitioners have had in the last 5 years. Names of proposed Training Supervisors and Program Director. Names of other health professionals (as listed above), including areas of health expertise and details of liaison/interface C. Evidence of Facilities Details regarding number of gynaecologic oncology beds in the unit Description of access to relevant diagnostic modalities, including CT, ultrasound and FNA cytology Description of facilities for high dependency care Description of facilities for assessment and follow-up Evidence of access to adequate library and information technology facilities D. Evidence of Activities Description and evidence of cancer register and data collection List of all current written and agreed treatment protocols implemented at the training unit Publications and Presentations: -- the Research Project -- List of publications, published and in preparation, in the last 5 years by practitioners working at a subspecialty level at the unit in all categories described below. Details of publications must include the title of the publication, authors, the name of the journal, and the date of publication. -- Gynaecologic malignancies -- Radiological and diagnostic investigations of gynaecologic malignancies -- Therapeutic management of patients with gynaecologic malignancies -- Surgical management of patients with gynaecologic malignancies -- Other -- List of presentations made by practitioners working at a subspecialty level in the unit at scientific meetings in the last 5 years. Details of presentations must include the title of the presentation, name/s of presenter/s, title of the conference or scientific meeting, and date of the presentation. Research -- List of current research projects in progress undertaken by trainees working at the subspecialty level in the unit. Details must include title of the research project, names of researchers, brief description of research, and expected completion dates. -- Details of opportunities for research to be completed by prospective trainees. -- List of other research projects the unit has been involved in over the past 5 years. Details must include name of 22

23 Part A: ADMINISTRATION Part A 3.0 Accreditation of CGO Training Units project, brief description of research, and how the unit was involved. Meetings -- Timetable of regular minuted Tumour Board/Clinicopathology meetings -- Timetable of regular education, peer review, practice review, and clinical management meetings at a subspecialty level -- Evidence of representation at hospital and local clinical, multidisciplinary and scientific meetings. Teaching -- Details of involvement in nurse, undergraduate and postgraduate level teaching. ranzcog/employment/itp-elective-a-subspecialty- trainee-positions.html This will keep RANZCOG subspecialties trainees informed of available subspecialties training positions and promote transparency. The accreditation of a training unit by the College may be reviewed by the CGO Subspecialty Committee if the College becomes aware of a unit not advertising training positions as per these accreditation requirements. Summary Unit accreditation and re-accreditation for CGO subspecialty training will depend on demonstrating the capacity to develop trainees across the whole subspecialty. Program Directors must advise the CGO Subspecialty Committee Chair, via College House staff, promptly if there is any change in workload, staff, facilities or activities. Training can take place in non-accredited training units, but such positions would be approved (for twelve months at a time) only after application in advance by a trainee registered with the College. Ultimately, responsibility for the trainee receiving suitable training will continue to rest with the trainee. The advantage in being an accredited training unit is that prospective trainees will know in advance that the unit has the capacity to offer them the training they need. The fact of the appointment will then ordinarily be accepted as evidence that their position is a suitable one. 3.3 ADVERTISING AccreditED CGO Training POSITIONS It is a requirement that RANZCOG accredited subspecialties training units promptly advertise all available subspecialty training positions on the College website and in the College Training and Assessment Bulletin (by notification to the College in writing). No fee applies. In each case, please complete the online template for training position advertisments on the website at 23

24 24 Part B: Curriculum

25 Part B: CURRICULUM Part B 1.0 aims 1.0 Aims 1.1 Subspecialist practice Gynaecological Oncology is a subspecialty of obstetrics and gynaecology. Gynaecological Oncologists are specialists in Obstetrics and Gynaecology, awarded the FRANZCOG, who have then completed a formal three year training program in gynaecological cancer care and have passed the examination for the CGO (Certificate of Gynaecological Oncology). She/he is competent in the comprehensive management of women with a gynaecological malignancy. The subspecialist will work in gynaecology with at least 66% of the time in gynaecological oncology. She/he will submit themselves for recertification every three years, and only those actively practising will continue to be certified. 1.2 Context The highly specialised field of Gynaecological Oncology has emerged as a result of a massive accumulation of new knowledge in gynaecological pathology and developments in clinical management, through the availability of new diagnostic techniques and treatments resulting in improved patient outcomes. The subspecialist will be required to keep abreast of this knowledge and ensure its application to the care of women who are at risk of or who are diagnosed with a gynaecological malignancy. Gynaecological Oncology is a recognised subspecialty and referral units for oncology patients have developed and contributed significantly to a reduction in mortality and morbidity from gynaecological malignancy. These subspecialists will be responsible for ensuring the highest standards of care for women with gynaecological cancer. The changing medico legal climate in Australia requires experts to keep abreast of the rapid pace of development in this field. A subspecialist in Gynaecological Oncology would be expected to promote clinical and basic research in this field and would function as a regional consultant in matters of organisation, standards, education and clinical practice in the subspecialty. 1.3 Aims of the Subspecialties The College introduced certification in the five subspecialties in order to: improve knowledge, practice, teaching and research promote the concentration of specialised expertise, special facilities and clinical material that will be of considerable benefit to some patients improve the recruitment of talented graduates into areas of recognised subspecialisation establish a close understanding and working relationship with other disciplines encourage co-ordinated management of relevant clinical services throughout a region accept a major regional responsibility for higher training, research and audit in areas of recognised subspecialisation establish, as far as possible, consistency in recruitment, training and assessment across areas of recognised subspecialisation The development of Gynaecological Oncology as a subspecialty of Gynaecology serves to enhance the importance of Gynaecology as an essential discipline and will encourage the recruitment of quality people into gynaecology in general and to the subspecialty in particular. 25

26 Part B: CURRICULUM 1.0 aims 1.4 Aims of the Subspecialty in Gynaecological Oncology The College introduced certification in the subspecialty of Gynaecological Oncology in order to: improve the education and skills of those specialists treating women with genital malignancy improve outcomes for these women promote research into the management of these diseases ensure that women receive the highest standards of care ensure that all women have access to subspecialist care in the management of gynaecological cancer 26

27 Part B: CURRICULUM Part B: 2.0 Objectives 2.0 Objectives of the CGO Training Program It is expected that the subspecialist in Gynaecologic Oncology will be able to demonstrate: Understanding of the aetiology, epidemiology, screening and prevention of gynaecological malignancy. Skills in a wide range of investigative procedures - including cystoscopy, sigmoidoscopy, thoraco-centesis, paracentesis and biopsy procedures. Should be able to at least describe the placement and care of long term central intravenous lines. Knowledge of the use, interpretation and indications for relevant ultrasonic, CT, lymphangiographic and other organ imaging techniques, such as MRI and PET scan. High level of skill in colposcopy and in the management and treatment of pre-invasive and micro-invasive lesions of the female genital tract. Knowledge of and skill in performing radical operations on organs of the female genital tract, and operations on the intestine, urinary and lympho-vascular systems, as required in the management of gynaecologic cancer. There should be a high standard of skill in the recognition and ability to manage the complications of treatment, if necessary, in association with other appropriately trained specialists. Knowledge of and skill in performing dissection of inguinal, pelvic, and para-aortic lymph nodes. There should be understanding of the available reconstructive procedures required for the restoration of pelvic organ function and an appropriate level of skill in performing such procedures. Knowledge of nutritional assessment, parenteral nutrition and intensive care management of the perioperative patient. Knowledge of and skills in the management of pain and the care of the terminally ill patient. Knowledge of the methods and techniques of radiation therapy, including intracavity and interstitial brachytherapy, external beam therapy and intraperitoneal radioisotope therapy. Participation in the planning of radiation treatment and understanding of the principles of radiobiology and radiation physics. Knowledge of and skills in the management of the side-effects and complications of radiotherapy. Advanced knowledge of the clinical pharmacology of cancer chemotherapy, the practical use of the various drugs required for treatment and skills in the management of toxic side-effects, including intraperitoneal chemotherapy. Competence in the assessment of the effects of treatment, and the long-term management of pre-invasive and invasive gynaecological malignancies. Knowledge of gross and microscopic pathology, immuno-histochemistry and molecular pathology relevant to gynaecologic oncology sufficient for interpretation of reports concerning gynaecological malignant histopathology. Skills in the planning, conduct and reporting of research in gynaecological oncology and a high level of skill in the interpretation and evaluation of research reports. Awareness of the complex psychosocial needs and demands of a patient with gynaecological cancer and the development of appropriate communication skills in dealing with these issues. Awareness of the need for multidisciplinary care in the management of gynaecological cancer and the development of appropriate relationships with other health professionals to deliver timely and appropriate multidisciplinary care. 27

28 Part Part B B: CURRICULUM aims KNOWLEDGE AND UNDERSTANDING 3.0 Knowledge and Understanding Knowledge and Understanding: The Building Blocks Required for the Development of Expertise in Gynaecological Oncology This section details areas of knowledge that underpin the practice of gynaecological oncology. The purpose is to grasp the underlying principles on which modern gynaecological oncology practice is based, not merely to memorise facts. Understanding of these principles will develop with regular clinical experience, for it is the interaction between knowledge and practice that provides the basis for growth in clinical expertise. The areas of knowledge presented in this section are categorized as follows: scientific knowledge that forms the building blocks underpinning clinical practice (Sections 3.1 to 3.9) clinical or applied knowledge that links the science and the practice of gynaecological oncology (Section 3.10) contextual knowledge (for example, consultation processes, business and management principles, professional expectations) that acknowledges the service obligations implicit in the practice of gynaecological oncology (Sections 3.11 to 3.14) Relevant knowledge may be accessed in a variety of ways, through text books, refereed articles in journals and book series, evidence-based electronic databases and publications, academic discourse, conference papers and many informal means of communication. It is through these publications and interactions that a consensus on standards is established for the discipline. Through these means, specialists certified in gynaecological oncology learn accepted terminologies, appropriate vocabulary, levels of understanding expected of them and key applications for their clinical work. As clinical professionals, they are expected to select, organize and test this knowledge through their own experience and in academic conversation with colleagues. 3.1 Epidemiology and Aetiology General Aim Know extensively the aetiology and epidemiological factors related to genital neoplasia. Specific Objectives Epidemiology Understand and describe the epidemiological factors related to genital neoplasia Aetiology Understand and describe the currently known effect of environmental, genetic and familial factors on carcinogenesis with particular respect to the female genital tract 28

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